Ass'n for Cmty. Affiliated Plans v. U.S. Dep't of Treasury

392 F. Supp. 3d 22
CourtCourt of Appeals for the D.C. Circuit
DecidedJuly 19, 2019
DocketCivil Case No. 18-2133 (RJL)
StatusPublished
Cited by2 cases

This text of 392 F. Supp. 3d 22 (Ass'n for Cmty. Affiliated Plans v. U.S. Dep't of Treasury) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ass'n for Cmty. Affiliated Plans v. U.S. Dep't of Treasury, 392 F. Supp. 3d 22 (D.C. Cir. 2019).

Opinion

RICHARD J. LEON, United States District Judge

This is an Administrative Procedure Act ("APA") challenge to an August 3, 2018 final rule ("2018 Rule"), 83 Fed. Reg. 38,212, promulgated by the Departments of Labor, Treasury, and Health and Human Services ("the Departments"). The 2018 Rule redefined "short-term, limited duration insurance" (or "STLDI"), a category of individual health insurance that Congress expressly exempted from individual market regulations in the Health Insurance Portability and Accountability Act of *261996 ("HIPAA") and did not address further in the 2010 Affordable Care Act ("ACA"). Plaintiffs are a collection of associations and organizations that directly or through their members offer individual health insurance coverage through ACA-created marketplaces ("insurer plaintiffs"), provide various medical services ("provider plaintiffs"), or purchase ACA-compliant individual health insurance ("consumer plaintiffs"). See Compl. [Dkt # 1] at ¶ 15. Plaintiffs claim that the 2018 Rule violates the APA, 5 U.S.C. § 706, by interpreting STLDI in a manner that is contrary to the ACA and/or HIPAA and is otherwise arbitrary and capricious. Id. at ¶¶ 97-123.

Pending before me are plaintiffs' and the Departments' cross-motions for summary judgment. See Pls.' Mot. for Summ. J. [Dkt. # 39]; Defs.' Mot. for Summ. J. [Dkt. # 40]. Upon consideration of the briefing, the relevant law, and the entire record herein, the Departments' motion for summary judgment is GRANTED and plaintiffs' motion for summary judgment is DENIED.

BACKGROUND

The story of STLDI begins in 1996. That was the year that Congress enacted HIPAA, a law designed in part to improve the availability and continuity of health insurance coverage in the individual and group markets. See Pub. L. No. 104-191, 110 Stat. 1936. HIPAA amended the Public Health Service Act ("PHS Act") to create federal standards for "individual health insurance coverage." See PHS Act § 2741, codified at 42 U.S.C. § 300gg-41, et seq. In doing so, the law defined "individual health insurance coverage" to mean "health insurance coverage offered to individuals in the individual market, but [that] does not include short-term limited duration insurance." Id. § 300gg-91(b)(5). That is, Congress in HIPAA exempted STLDI from individual market regulations. Congress did not, however, define what coverage constitutes STLDI.

HIPAA also imposed several reforms on the individual health insurance market. For those seeking individual policies, the law guaranteed coverage availability and preexisting condition protections to "eligible individual[s]," i.e., persons with "18 or more months" of "creditable coverage," id. §§ 300gg-41(a)(1), (b)(1)(A), without any "significant breaks in coverage" lasting 63 or more days, id. § 300gg-3(c)(2)(A). HIPAA defined "creditable coverage" to include most forms of health coverage, including STLDI (notwithstanding STLDI's exemption from individual health insurance regulations). See id. § 300gg-3(c)(1)(B); H.R. Rep. No. 104-736, at 180 (1996) ("The conferees intend that creditable coverage includes short-term, limited coverage."); 45 C.F.R. § 146.113(a)(1)(ii) (STLDI is a type of "health insurance coverage"). In addition, HIPAA capped the period during which a group health insurer could exclude benefits for preexisting conditions to 12 months from enrollment (or 18 months for late enrollees) and required that the period be "reduced by the aggregate of the periods of creditable coverage" for the individual seeking to participate in the plan. HIPAA, Pub. L. No. 104-191, § 2701(a)(2)-(3). In sum, individuals who changed plans under certain circumstances were afforded day-for-day credit for their previous coverage, which served to protect them in full or in part from benefit denials for preexisting conditions under their new coverage.

With Congress having created and exempted an undefined category of health insurance, the Departments, predictably, stepped in to give STLDI meaning. In April 1997, during the Clinton Administration, the Departments published an interim final rule ("1997 Rule") defining STLDI as "health insurance coverage provided *27pursuant to a contract with an issuer that has an expiration date specified in the contract (taking into account any extensions that may be elected by the policyholder without the issuer's consent) that is within 12 months of the date such contract becomes effective." 62 Fed. Reg. 16,894, 16,928 (Apr. 8, 1997).1 The Departments during the Bush Administration followed up in 2004 with a final rule ("2004 Rule"), which adopted effectively the same definition as the 1997 Rule without opposition or comment. See 69 Fed. Reg. 78,720, 78,748 (Dec. 30, 2004).

In 2010, fourteen years after STLDI's debut in HIPAA, Congress passed the ACA, which overhauled the operation of individual health insurance markets in order "to increase the number of Americans covered by health insurance and decrease the cost of health care." Nat'l Fed. of Indep. Bus. v. Sebelius, 567 U.S. 519, 538, 132 S.Ct. 2566, 183 L.Ed.2d 450 (2012). Among the ACA's reforms were: (1) "guaranteed issue," requiring insurers to offer coverage to all individuals regardless of health status and to accept every individual who applies for such coverage, see 42 U.S.C. § 300g

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Bluebook (online)
392 F. Supp. 3d 22, Counsel Stack Legal Research, https://law.counselstack.com/opinion/assn-for-cmty-affiliated-plans-v-us-dept-of-treasury-cadc-2019.